At last week’s meeting, our esteemed member, Dr. Harold Elner, MD, called upon his career as a specialist in urology to give us the basic structure, functions, diseases and remedies for the genito-urinary system. All in the space of 25 minutes or so. And he kept it “clean,” PG-rated at most. President Ryan Hamilton expressed appreciation for Dr. Hal’s educational talk and for his discretely avoiding the really graphic stuff. Here is a sample:
- Regarding prostatic cancer, there is the eponymous “three-legged stool” required for diagnosis, to wit, PSA, digital examination, and biopsy. When it occurs in relatively younger men (40s or 50s) a radical approach is often chosen. At times this can result in incontinence and, frequently, impotence.
- Benign enlargement of the prostate, when it reaches a point wherein one experiences frequency of urination, getting up at night three or more times, and a slow/weak output, surgery had mainly been the treatment. This surgery has most often been through an instrument. More recently, drugs that relax the bladder outlet have come into vogue. Use of these has allowed the deferment or avoidance of surgery.
- Any blood in the urine, in even microscopic amounts, and particularly painless, must be investigated. A physician who does not do this is remiss. There are instances in which patients have been treated for assumed infection when there has lurked a malignancy or an enlarging stone.
- As stated, the treatment for kidney or ureteral stones too large to pass had been open surgery. Enter then the Dornier Company in Germany, those fine folks who gave us the long-range WWII bombers. They were experimenting with shock waves to de-ice the wings of the planes. At times these waves shattered the glass on the instrument panels. It was then thought to use this principle to shatter things that needed shattering. Thus arose the lithotripter, in which shocks generated by a condenser were focused on the stones (aka calculi), pulverizing them. Since then, refinements have made the process less cumbersome. A preferred method is to pass a probe into the ureter and blasting the stone with the laser. Ergo, open surgery for urinary calculi is now only rarely done. Anyone who has experienced the agony of a stone can appreciate the relief afforded by these treatment modalities.
Generally speaking, a patient in such a situation moves about looking for a comfortable position (there isn’t one). This contrasts with someone who has an event within the abdomen (i.e. acute appendicitis) and who lies very still.
Conclusion and Comment: Sooner or later, everyone meets the urologist.
*The drawings used in this presentation were by the celebrated medical artist, Frank Netter, M.D. Dr. Netter was a graduate of DeWitt Clinton High School, Bronx (preceding the speaker there by about a generation). His artistic talent was such that he left his medical practice to devote full time to these drawings that are known worldwide.